Romero CCR

Language: Spanish
References: 22
Page: 329-338
PDF size: 82.20 Kb.

ABSTRACT

Background: The reliability and validity of the biochemical variables of clinical importance as the analites: Na, K , Ca, glycemia, HTO and hemoglobin in making decisions in an unit of intensive care (ICU), continuous admission (AC) is vital for the diagnosis, management and prognosis of the critically ill patient.
Objective: To determine agreement of Na, K, Ca, glycemia and hemoglobin and hematocrito between standard conventional laboratory and portable analyzer integrated to arterial gasometer.
Patients and methods: In a crossover study done at Intensive Care Unit of the UMAE Nº 134, IMSS, CMN Torreón, Coah, Méx., 50 serial subjects, who entered to the ICU (41) and AC (9) in critical state, were studied. Venous and arterial samples were taken to serum-plasma analysis of analites with analyzer of standard laboratory vs. analyzer (IL GEM Premier 3000). Descriptive statistics and interclass correlation coefficient (CCI) were used, IC to 95%.
Results: The CCI of plasmatic-plasmatic samples for blood gas analyzer integrant (BGAI) had a good-good agreement. The serum-plasma analites had moderate-good agreement. The K+ plasma-plasma (BGAI), with CCI = 0.8635 IC 95% (0.7689 - 0.9207) F = 14.33, p = 0.00000.
Conclusions: The discrepancy among serum-plasma samples show a systematic error evident for low CCI, IC 95% wide at level serum. The plasmatic K+ is the statistically consistent variable in IL GEM Premier 3000.

REFERENCES

1. Boquet Jimenez E, Castillo de Sánchez ML, Caceres de Maselli AL y col. Mejoría continua de la calidad. Guía para los laboratorios de América Latina. México: Panamericana, 1996.

2. Smyrnos N, Curley FJ, Irwin RS. Monitorización en la unidad de cuidados intensivos. En: Richard S Irwin, James M Rippe. Cuidados intensivos. Barcelona: Marban, 2002;pp:106-10.

3. Murhy MM. Monitoring the emergency patient. In: Medicine of Emergency. Pág: 119-123.

4. Parsa MH, Shoemaker WC. Monitoreo. En: Tratado de Medicina Crítica y Terapia intensiva. 3a ed. México: Médica Panamericana, 1996;pp:234-331.

5. Fernández PS, Díaz SP. La fiabilidad de las mediciones clínicas: análisis de concordancia para variables numéricas. Http://www.fisterra.com/mbe/investiga/conc_numerica/conc_numerica.htm.

6. Cerón-Díaz WL. Errores en las mediciones en la unidad de terapia intensiva. En: Esponda-Sierra-Ceron. Síndromes cardiopulmonares en el paciente grave. México: McGraw-Hill Interamericana, 2001;pp:133-55.

7. Bartko JJ. The intraclass correlation coeficient as a measure of reability. Psychol Rep 1966;19:3-11.

8. Fleiss JL. Measurement agreement between two judges on the presence or abscence of a trait. Biometrics 1975;31:655-59.

9. Burdock EI, Fleiss JL, Hardesty AS. A new view of interobserver agreement. Pers Psychol 1963;16:373-84.

10. Prieto L, Lamarca R, Casado A. La evaluación de la fiabilidad en las observaciones clínicas: el coeficiente de correlación intraclase. Med Clin (Barc) 1998;110(4):142-45.

11. Cañedo-Dorantes L. Diseño estadístico de la muestra. En: Investigación Clínica. Capítulo 9. México: Interamericana-McGraw-Hill, 1987;pp:143-58.

12. Guyton AG. Hemostasia y coagulación sanguínea. En: Tratado de fisiología médica. 8a ed. México: McGraw-Hill Interamericana, 1992;pp:405-15.

13. Guyton AG, Hall JE. Los compartimientos líquidos del cuerpo: líquido extracelular e intracelular; líquido intersticial y edema. Cap 25. En: Tratado de fisiología médica. 10a ed. México: McGraw-Hill Interamericana 2001;pp:319-37.

14. Procedures for the collection of arterial blood specimens; Approved Standard. 3rd ed. NCCLS document H11-A3, NCCLS 940 West Valley Road, Suite 1400, Wayne, PA 1987-1989, 1999.

15. Severinghouse JW. Simple accurate equations for human blood = 2 disociation computations. J Appl Physiol 46:599-602.

16. American Diabetes Association. Bedside blood glucose monitoring in hospitals. Diabetes Care 2003;26(S1):S119.

17. Ora Paltiel, Salakhov E, Ronen I, Berg D, Israeli B, MD. Management of severe hypokalemia in hospitalized patients. Arch Intern Med 2001;161:1089-95.

18. Mota HF, Velásquez JE. Potasio. En: Trastornos clínicos de agua y electrólitos. 1a ed. México: McGraw-Hill Interamericana, 2004;pp:89-115.

19. Henry JB. Clinical diagnosis and management by laboratory methods. 18th ed. Philadelphia: Saunders Co., 1991.

20. Tietz NW. Fundamentals of Clinical Chemistry. 4th ed. Philadelphia: WB Saunders, 1996.

21. Interference Testing in Clinical Chemistry-Proposed Guideline, NCCLS Document EP7-P, Vol 6(13).

22. Eric S, Lida D, Clive M. Alteraciones del sodio y potasio plasmático. Capítulo 60. En: Irwin RS, Rippe JM. Manual de Cuidados Intensivos. 3a ed. Barcelona: Marban, 2002;pp:361-65.